AbstractThis article presents the epidemiological situation of HIV and AIDS in France
as of 31 December 2007, based on the surveillance activities coordinated by
Institut de veille sanitaire (InVS): mandatory notification of AIDS and HIV
infection, surveillance of HIV subtypes and screening activity.
In 2007, five million HIV tests were performed, representing a steady number
since 2006, and the number of HIV positive tests was about 10,600.
Due to reporting delays and under-reporting, the total number of newly
diagnosed HIV cases is estimated at 6,500 [CI95%: 6,300-6,800] in 2007,
declining since 2004, when 7,500 [CI95%: 7,100-7,900] subjects had been
newly tested HIV positive.
Six out of ten people newly HIV diagnosed in 2007 were infected through
heterosexual contact, of whom half were from Sub-Saharan Africa.
Nevertheless, the number of new diagnoses has decreased since 2003 in
foreign women, and since 2005 in foreign men. The number of new diagnoses in homosexual men has increased between
2003 and 2006, then seems to be stabilizing in 2007. Homosexual men
accounted for 38% of the total number of new HIV diagnoses.
The proportion of newly diagnosed cases of HIV-2 infections is 2% in 2007.
Among HIV-1 infections, the proportion of non-B subtypes, having decreased
between 2003 and 2005, has remained stable in 2006 and 2007 (40%).
The 2004 to 2007 period is characterised by a decrease in the number of new
HIV diagnoses. This trend is mainly explained by the decrease in the number
of new diagnoses among people from Sub-Saharan Africa; meanwhile the
number of new diagnoses has increased among men who have sex with men.
This last observation, together with the increase in sexually transmitted
infections, shows that men who have sex with men keep on having high risk
behaviours, and that they are not sensitive to the many prevention messages,
despite the diversity of preventive actions towards this population.

AbstractObjectives – The aim of the ONCOVIH study was to describe the distribution
of malignancies, one of the main cause of morbidity and mortality in
HIV-infected patients, and the one year survival of these patients in France.
Methods – ONCOVIH was a national cross-sectional study with a prospective
reporting of all new cases of malignancies diagnosed in HIV infected
patients between 01/01/2006 and 31/12/2006. Characteristics of HIV infection
and malignancy at diagnosis of cancer, occurrence and cause of death during
the first year following the diagnosis were collected. To compare these
characteristics to those in HIV-infected patients, data from HIV patients
followed in the cohort ANRS CO4-FHDH were extracted.Results – Overall, in 2006, 694 new malignancies were reported in 690
patients, with available characteristics at malignancy diagnosis in 669 patients.
Among the 349 clinical centers participating in the study, 282 had reported at
least one malignancy. Most common malignancies were Non-Hodgkin’s
Lymphoma (NHL) (21.5%), Kaposi’s sarcoma (16.0%), lung cancer (9.4%),
anal cancer (8.2%), Hodgkin’s lymphoma (7.6%), cutaneous non-melanoma
(6.8%), and liver cancers (5.6%).
Median age at cancer diagnosis was 47 years (interquartile range
(IQR)=41-55). Compared to HIV-infected patients followed in ANRS
CO4-FHDH (454, IQR=312-634), median CD4 cell counts were lower in patients diagnosed in ONCOVIH with AIDS (193, IQR=67-357 p<0.0001) and
non-AIDS defining malignancies (329, IQR=193-500 p<0.0001). Patients
diagnosed with AIDS defining malignancies were less likely to receive cART
with a plasma viral load under 500 copies/mL than patients followed in
ANRS CO4-FHDH (23% and 67% p<0.0001).
With 185 deaths, the overall one-year survival rate was 72% (CI95%: 68-75%)
being much lower after a diagnosis of lung cancer (35%), hepatocarcinoma
(47%), and NHL (65%).Conclusion – In 2006, almost two thirds of diagnosed malignancies in
HIV-infected patients were non-AIDS defining. Our results suggest that
prevention of malignancies in HIV-infected patients requires a better control
of HIV replication and its associated immunodeficiency in addition to the
prevention of other risk factors, such as smoking.

AbstractIntroduction – This study presents the trends in mortality due to HIV
infection since 1987, and for the period 2000-2006, the characteristics of
deaths in HIV infected persons.Methods – The data are based on the national statistics on causes of deaths,
annually produced by the French Centre for the Epidemiology on Causes of
Death (Inserm-CépiDc). The study concerns HIV as the underlying cause of death
between 1987 and 2006 and as contributing cause over the period 2000-2006. Results – Between 1987 and 2006, the mortality due to HIV infection shows three important phases: the last one showing a tendency to stability between
2000 and 2006. Deaths mainly occur among men, but the rate of female
deaths is in progress. Young people between 25 and 34 years old are far less
affected than in the 1980-1990 period. Unlike other age groups, mortality has
been increasing in the 45-54 age groups. In 2006, 809 deaths were notified as
related to HIV infection, mainly due to infectious and parasitic diseases.
For 330 deaths, the infection existed but was reported as a contributory
cause: cancer, cardiovascular disease and violent deaths being stated as the
underlying cause of death.Conclusion – The spectacular decline of deaths due to HIV after the end of
the 1980s in metropolitan France is the result of better treatments and
prevention efforts. The more and more diverse nature of death causes must
enhance the risk factors of a population not infected by HIV (lifestyles,
smoking, alcohol, overweight…) in prevention measures, in addition to
specific HIV prevention.

AbstractIntroduction – The interaction between HIV infection and STIs is complex.
STIs increase HIV transmission, and inversely. This survey aimed at describing
the prevalence of HIV infection among patients for whom a diagnosis of STI
(syphilis, gonorrhoea and lymphogranuloma venereum (LGV)) was notified
to the RésIST surveillance system between 2000 and 2007.Method – The surveillance of STIs is voluntary and prospective in metropolitan
France, and overseas counties. It is based on the participation of
Information Centers for the screening and diagnosis of STIs (Ciddist),
hospital or private practitioners consultations. Case definitions include clinical
and biological criteria. Questionnaires with clinical data are completed by
the clinician, whereas behavioural data are documented directly by the
patient in a self-administered questionnaire on sexual practices in the
12 months preceding the STI diagnosis. Both anonymous questionnaires are
sent to the French Institute for Public Health Surveillance by the clinician.Results – During the study period, 2,892 case of syphilis, 653 cases of
gonorrhoea, and 567 cases of LGV were notified. The prevalence of HIV
infection was 16%, 45% and 90% respectively for patients with gonorrhoea,
syphilis and LGV. All LGV+ patients were homosexual. For gonorrhoea and
syphilis, the prevalence of HIV infection varied according to sexual orientation,
the prevalence was higher in homo-bisexual men (23% and 51%
respectively) than in heterosexual men (3% and 16%) and females (3% and
6%). Among HIV+ patients, the proportion of patients who discovered their
HIV infection was high: 18% for patients with gonorrhoea, and 12% for
patients with syphilis.Conclusion – The prevalence of HIV infection among patients with one of
the three STIs (syphilis, gonorrhoea and LGV) is high and a non-negligible
proportion of patients discover their HIV infection at the same time as STI
diagnosis. Efforts for promoting primary and secondary prevention for HIV
infection and STIs in cases as well as in sexual partners should be pursued.

AbstractIntroduction – This study aims at assessing the acceptability of a systematic
proposal of HIV screening using rapid tests, by adults consulting in
the emergency department of a hospital.Material and methods – Systematic proposal of HIV screening to any
adult patient admitted in the emergency department and requiring a blood
sample. Monocentric prospective study in a hospital in suburban Paris from
January to April 2008 (Hôpital Louis Mourier, Colombes, Hauts-de-Seine).Results – Among the 579 eligible patients, 511 (88%) accepted being tested.
More than half of the consultants had never carried out a HIV test before.
Approximately 16% of the patients who accepted to be tested had at least one
risk factor for HIV, and 43% of these had never carried out a HIV test. Three
HIV rapid tests returned positive. For one patient, it was the discovery of a
HIV infection, and for the two other patients, the seropositivity was known
beforehand but denied. Two out of three were from Africa, and the third had
homosexual practices. All the patients received their result orally before
leaving the emergency department.Discussion-Conclusion – HIV testing using a rapid test is well accepted
by the population consulting in this emergency department. The selection of
patients through some simple questions could make it possible to propose
testing to people who are « at risk », but have never been tested before.